Utilization Management Coordinator

Job description

Job Description A bit about this role: The Utilization Management Coordinator plays a vital role in supporting Clinical Operations by managing the intake, prior authorization, and clinical coordination workflows. This role ensures timely case intake, accurate authorization set-up, and effective coordination with members, providers, and internal clinical teams to support care transitions and authorization processes. The coordinator will be an important part of building strong relationships with health care providers through proactive communication, managing key operational processes to enable efficient, high-quality clinical decisions. This is a fast-paced environment that requires exceptional organization, attention to detail, and a natural talent for customer service. We often require management of several tasks at once, so enthusiasm and organization are key. Utilization Management is a heavily regulated space, so you’ll work through unexpected situations and evolving guidance — including periodic CMS audits where the whole team pitches in on research and root cause. Schedule: This is a full-time, remote position working five 8-hour days per week. Shifts are scheduled between 8:00 AM and 8:00 PM ET, with staggered schedules across the team to ensure seven-day coverage. We are hiring for: Monday – Friday Tuesday – Saturday Sunday – Thursday Your specific start time is assigned within the 8:00 AM – 8:00 PM ET window. We’ll ask about your schedule preference during the process and will do our best to match it. Because we’re filling a limited number of openings on each schedule, availability changes as roles are filled — so we ask that candidates be open to more than one schedule where possible. Your responsibilities and impact will include: Intake Management Monitor intake queues, including daily census validation checks Manage inbound and outbound correspondence Ensure referrals and cases are accurately entered into our system or re-routed to delegates as applicable Prior Authorization Support Perform authorization set-up and case creation in our systems Manage and resolve authorization-related inquiries across multiple case types Review member inpatient status and clinical documentation to support episode updates Ensure required documentation is present for clinical review and determination, including request for information (RFI) work and electronic health record (EHR) access Clinical Coordination & Communication Conduct outbound calls to members and providers to obtain clinical information and communicate UM decisions Schedule and coordinate peer-to-peer (P2P) reviews between providers and Medical Directors Manage Medical Director case assignments and tracking Retrieve medical records via hospital EHR portals and external systems Support the clinical team with case coordination and documentation needs Post-Discharge & Transitional Care Coordination Contact inpatient and post-acute facilities to confirm admission and discharge details Complete daily census checks and assist with discharge planning coordination activities Support care transition workflows and case follow-up Operational & Reporting Support Download and review operational reports (e.g., Looker, Snowflake) Support RFIs and case tracking in inpatient and UM tools Maintain accurate case status and documentation in our system Provide operational and administrative support to the assigned team and manager Required skills and experience: High school diploma or equivalent Experience in healthcare operations, utilization management, care coordination, or prior authorization Proficiency with healthcare systems, EHRs, and reporting tools Effective communication skills with providers and members Strong organizational and multitasking skills in a high-volume environment Attention to detail, follow-through, and time management in a frequently changing environment Desired skills and experience: Prior experience in Medicare Advantage or managed care Intake, authorization, or clinical coordination experience Familiarity with UM or case management workflows 1–3 years of administrative or medical office experience Proficiency with Google Sheets and the Google Workspace suite Bilingual #LI-Remote Salary Range: $21.70 - $27.00/ hour The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes: Employer sponsored health, dental and vision plan with low or no premium Generous paid time off $100 monthly mobile or internet stipend Stock options for all employees Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles Parental leave program 401K program And more.... *Our total rewards package is for full time employees only. Intern and Contract positions are not eligible. Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience. Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business. As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.